Provider Demographics
NPI:1588399737
Name:DEGRAFF, LISA ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DEGRAFF
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:DEGRAFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:866 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8542
Mailing Address - Country:US
Mailing Address - Phone:559-960-0929
Mailing Address - Fax:559-241-6609
Practice Address - Street 1:866 PARK AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8542
Practice Address - Country:US
Practice Address - Phone:559-960-0929
Practice Address - Fax:559-241-6609
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021818363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health